2 Nov 2010

Death sparks debate on Jehovah's Witness transfusion ban

National Post - Canada July 14, 2009

Death sparks debate on Jehovah's Witness transfusion ban

by Tom Blackwell | National Post

A teenage Jehovah's Witness who triggered a cross-country court battle when she refused blood transfusions as part of her cancer therapy has died, renewing debate about the religion's blood ban and its impact on children.

Sarah Bahris, 19, died earlier this month in Vernon, B.C., four years after her case captured national attention, with the young patient eventually ending up in a New York City hospital that offers bloodless chemotherapy.

Ms. Bahris had appeared to be cancer free and as recently as mid-2008 spoke of travelling the world and do development work, said a lawyer who knew the young woman. The family was "devastated" earlier this year, however, to learn that the disease had returned, her father, Kelly Bahris, said in a statement provided to the National Post.

"We will always remember Sarah's infectious laugh, indomitable spirit and her compassion," Mr. Bahris wrote. "We miss her very much and are still grieving."

Her case was one of one of the most high-profile in a string of emotional disputes over the Jehovah's Witnesses' prohibition on receiving blood transfusions, which applies even to children under the age of consent. Child-welfare authorities have repeatedly stepped in and asked the courts to order that transfusions be allowed. The Supreme Court of Canada ruled in a major decision last month, though, that minors sometimes have the right to turn down blood if they are deemed by a court to be mature enough.

B.C. child welfare authorities obtained a court order in 2005 to ensure Ms. Bahris received a transfusion if necessary as part of treatment for osteogenic sarcoma, the same bone cancer that killed Terry Fox. Chemotherapy can lower blood counts to the point where patients become dangerously anemic.

The family then took her to Ontario, where another court case ensued, with a judge eventually ordering Ms. Bahris back to British Columbia. Provincial authorities there later agreed that she could be treated at the Schneider Children's Hospital in New York, which offers chemotherapy without transfusions.

The case is disturbing because the pressures of the church -- which expels members who accept blood transfusions -- make free choice all but impossible for a child, said Dr. Ian Mitchell, a pediatrician and head of medical ethics at the University of Calgary.

"There is absolutely no way -- where someone has been told their entire life ‘You'll lose your chance at eternity if you accept blood' -- that you could accept blood," said Dr. Mitchell, who follows the Jehovah's Witness blood controversy closely. "She may feel it's a free decision, but it couldn't possibly be."

No one can say what would have happened had the teen's health care gone ahead without the interruption of legal proceedings, but the weeks-long dispute and the delay in chemotherapy would mean "you're less likely to get a good outcome," said Dr. Mitchell.

The prognosis for osteogenic sarcoma -- a disease that affects primarily adolescents and young adults -- has greatly improved since Mr. Fox died in 1981. While 90% of patients would have died 20 years ago, the death rate has dropped to about 30%-40%, said Dr. Malcolm Moore, head of medical oncology at Toronto's Princess Margaret Hospital.

When the cancer is still localized and stopped in its tracks with surgery, radiation and chemo, patients can essentially be cured, he said. If it returns in a different part of the body, however, the prognosis is grim, said Dr. Moore.

As for transfusions, he said the majority of chemotherapy patients never need blood, and he and other oncologists have treated Jehovah's Witnesses in ways that avoid blood.

David Day, a Newfoundland lawyer who handled the recent Supreme Court case and dozens of other Jehovah's Witness transfusion disputes, rejected the notion that Witness children are incapable of freely choosing how to be treated. When asked to represent young patients, he said he insists on talking to them with no other adults present. In 41 such cases since 1987, Mr. Day said he has only felt seven or eight of the children were unduly influenced by adults, and declined to take the cases.

The lawyer said he did consulting work on Ms. Bahris's case and had no doubt that she was competent to determine her own treatment, describing her as an articulate girl with a well-developed understanding of death.

"She was an exceptionally ambitious young woman," Mr. Day said. "When I spoke to her last year, she expressed the view that she wanted to travel internationally and wanted to work with underprivileged individuals ... She was very quick-witted, she was exceptionally well read."

In a quiet postscript to the episode in 2006, the Ontario Court of Appeal overturned the decision ordering Ms. Bahris back to B.C., though by then the issue was moot.

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The Montreal Gazette - July 3, 2009

Age alone is not the measure of maturity


The Supreme Court of Canada has granted adolescents a say in serious medical decisions that affect them - provided they demonstrate the necessary level of maturity.

The judgment, in a decision announced last week, is part of a trend in Canada: The state is agreeing to allow adolescents greater personal responsibility, under carefully-circumscribed conditions.The 2003 Youth Criminal Justice Act signalled Parliament's desire to treat teens as individuals in criminal matters, assessing ability to assume responsibility on a case-by-case basis. This new ruling extends the principle to medical treatment.

Until this Supreme Court decision, the level of maturity required for medical treatment decisions had been determined by age alone - an admittedly arbitrary measure made worse because it varied from province to province. Quebec's age of consent was 14; Saskatchewan's was 18.

The Supreme Court decision means that age alone can no longer be used as a cutoff. Instead, judges must now weigh age and maturity "on a sliding scale," setting them against the seriousness of the threat to the youngster's health and well-being. Making these assessments will not be simple, but the principle is sound.

In 2006, a 14-year-old Manitoba girl, a Jehovah's Witness, argued that she was competent to refuse a court-ordered blood transfusion that doctors had determined was necessary to treat bleeding associated with Crohn's disease. (Jehovah's Witnesses believe the Bible bans the "ingestion" of blood.) Three psychiatrists found she was not mentally ill, nor in thrall to her parents. Yet because 16 was the age of consent to medical treatment in Manitoba, the government was able to order her to accept transfusions.

The Supreme Court held that when an adolescent is found capable of making a "truly mature and independent decision," the young person can be allowed to make even a decision with potentially very serious consequences. At the same time, the court said the state has an undeniable duty of care toward youngsters and must recognize that there are limits to their developing maturity.

The ruling properly takes a nuanced approach to the rights and responsibilities of young Canadians. It is wrong, on the basis of age alone, to deny a young person any say in what happens to him or her. Maturity can develop early - or late - in adolescence.

This Supreme Court decision is a new step along the way to conferring on mature teenagers the right to exercise informed choice. It is a step in the right direction.

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